abc@brl-tgr.ARPA (Brint Cooper ) (12/17/85)
The following item is reproduced from the Arpanet discussion group on
Risks of (in?) Computer Systems. I thought it would make interesting
discussion here. Although I posted a response, I have not done so here,
hoping to see what you folks say.
I'm especially interested in the views of present or future medical and
pharmaceutical (sp?) professionals.
Brint
Date: Tue, 10 Dec 85 09:50 PST
From: Dave Platt <Dave-Platt%LADC@CISL-SERVICE-MULTICS.ARPA>
To: RISKS <RISKS@SRI-CSL.ARPA>
Subject: Risks re computer-compared prescriptions
Random-Quote: The race is not always to the swift, nor the battle to the strong
-- but that's the way to bet. (DAMON RUNYON)
Recently, an increasing number of pharmacies have been putting greater
amounts of drug information "on line". As I understand it, they will keep
track of all of a particular customer's prescriptions, and will alert the
pharmacist if they should be asked to fill a prescription that conflicts
with any other medication that the customer is taking. The rationale is, I
believe, that if a person is receiving prescriptions from two different
doctors (different specialists, perhaps), then neither of the doctors would
necessarily be aware of the drugs that the other had prescribed, or of any
possible unfortunate interactions between the drugs. Normally, I assume
that the pharmacist would inform the consumer and contact the prescribing
doctor for further instructions.
Several concerns come to mind:
- Where is the database of drug conflicts derived from? Manufacturers'
data files? FDA reports? Articles in recent medical journals? Just
how complete is it?
- Does the database cover only drug-to-drug interactions, or is it more
complete? Might it, for example, contain counter-indication information
for specific drugs (e.g., don't take this if you're pregnant)? How about
reports of unusual symptoms or side effects?
- How "intelligent" (sorry!) is the logic that compares a new prescription
with a person's medical/drug history? Is there any AI/expert-system
capability, or is it simply a look-up-a-list-of-conflicts? Might the
code be capable of, for example, warning a person who's receiving
medication for asthma not to take doses of a specific brand of antibiotic
because that particular brand is preserved with a sulphite compound that
has been reported to trigger asthma attacks in sensitive individuals?
- If a pharmacy advertises their new drug-checking software (and some do
mention it in their ads), are they assuming any degree of responsibility
or liability for either (a) false "conflict exists" warnings that cause
a consumer not to take a necessary drug prescribed for them, or (b)
any failure to alert a customer to a conflict that does exist?
- Will doctors, pharmacists, and/or consumers begin to depend on the
correct functioning systems such as this, at the expense of studying
the issues involved themselves?
This particular issue is similar to the one discussed several issues back,
concerning AI/KE/expert-system tools such as MYCIN that "diagnose"
illnesses from symptoms or "suggest" treatments. However, this system
is one step further away from the doctor and closer to the consumer;
there might be a greater tendency for people to "take it at its word"
rather than simply using it as a tool.